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title: Hormone replacement therapy
x-toc-enable: true
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## Table of contents {#pagetop}
-  [Introduction](#intro)
-  [Private vs NHS](#privateVSnhs)
-  [Age and gender specific info](#specific)
-  [How to buy HRT youself](#buy)
-  [Suppliers](#suppliers)



## Introduction {#intro}

Hormone replacement therapy, or HRT, is way to align some of your
secondary sexual characteristics (e.g. enlarged breasts and paler skin
color for women, and larger muscles and facial hair for men) with your
gender identity. There are two types of therapy,
[feminizing](feminizing) and [masculinizing](masculinizing) HRT, and
there is some leeway in the dosage and other parameters to cater to
non-binary people too. Some of the effects of these are permanent
(breast growth, nipple enlargement, facial hair growth, and
potentially becoming sterile), while the rest are temporary, and so
require a constant use for the rest of the life. In addition to the
physical changes, hormone replacement therapy tends to bring the mind
to ease as the body dysphoria is reduced.

Aquiring hormones from pharmacies requires a doctor's prescription in
most countries. An alternative is to buy them from unnoficial
channels. In most countries the national healthcare system offers a
treatment path for transgender patients. This is typically cheap, but
takes very long and is full of gatekeepers who might want to see you
act in a certain way before starting the treatment. Another option is
to get a prescription from a private clinic. This is faster and more
expensive, but depending on the doctor might be worth it. Contact your
local LGBT or trans groups for suggestions and warnings about bad
doctors, or check your [country-specific](index.md#country)
instructions at Transit. The third option is to do-it-yourself. We
have instructions on [dosage](#specific) that has worked for trans
people and also on how to [buy](#buy) hormones online.


### Feminizing HRT {#feminizing}

With feminizing hormones, several things will happen to you, among
others:

-   You will probably develop breasts (to the size of a typical cis
    women) over the course of a few years
-   Your hips will probably widen (over the course of years)
-   Body hair growth (but not facial hair growth) will be reduced
    (within 6 months usually). The body hair that does grow will be
    thinner and less visible. You will stop needing to shave your body
    as much.
-   body fat will redistribute to be more female generally (e.g. more
    fat in your thighs)
-   Body odour will feminize (You'll smell female, not male)
-   The size of your testicles will decrease
-   Your libido (desire for sex) will seriously decrease
-   Emotional changes: your emotions will feel more intense (you're not
    going to go mad, you'll still be in control and you'll normalise
    after a while to be more stable). They will change the way that you
    think, basically.
-   Your skin (whole body) will soften, your veins will become less
    visible
-   Decreased muscle mass and strength. E.g. the muscles around your
    shoulders and upper body will go down
-   Decreased acne, skin will become less oily
-   You might lose the ability to ejaculate
-   You will become infertile

More information is on [this Wikipedia
article](https://en.wikipedia.org/wiki/Hormone_replacement_therapy_%28male-to-female%29)



### Masculinizing HRT {#masculinizing}

With masculinizing hormones, several things will happen to you, among
others:

-   You will start growing body and facial hair
-   Your voice will start deepening
-   You'll get male pattern baldness when you're older (scalp hair)
-   Potentially increased libido
-   Emotional changes (varies depending on person)
-   Increase sweat and body odour production
-   Periods will eventually stop (at higher doses of testosterone)

More information is on [this Wikipedia
article](https://en.wikipedia.org/wiki/Hormone_replacement_therapy_%28female-to-male%29).


## Private care vs NHS {#privateVSnhs}

NHS typically follows a set of [*standards of
care*](https://en.wikipedia.org/wiki/Standards_of_Care_for_the_Health_of_Transsexual%2C_Transgender%2C_and_Gender_Nonconforming_People)
for the assessment and treatment of transgender people. In most
countries the NHS is severely underfunded and understaffed, so they
would provide some service to transgender individuals, but not
necessarily all that would be required to fully transition by a
particular individual. Moreover the NHS has usually long waiting
times, both in terms of getting to the first appointment, and to
finally receive medical treatment. Typically they would require a
lengthy process of being evaluated by psychologists for "suitability
of transitioning". This is *gatekeeping*, and we at Transit oppose it
vehemently. In some places the gatekeeping process might be hidden
under the term "differential diagnosis", whereby the psychologist
tries to identify if you have some mental health issues (besides
gender dysphoria) that might explain your feelings. It is still
gatekeeping. Even people with mental health issues (e.g. depression)
should be allowed to transition.

Private care is faster but more expensive. The price depends much on
what sort of treatment is being sought. Hormone replacement therapy is
quite cheap. The only large expenses involved in starting HRT are the
blood tests. We recommend getting the blood tests done at the NHS if
possible, and provide the results to the private clinic if money is a
concern. In relation to other treatments, whenever there's surgery
involved private care is very expensive and you should budget well if
going this path.

Besides time and money there's the concern of quality in considering
NHS against private care. This depends mostly on country, but a rule
of thumb is that a specialized private clinic will provide better
quality services and it costs more. In relation to hormone replacement
therapy there is not really a big variance in the service provided.
The results of genital surgery and voice therapy can go from bearable
to extremely good depending on the service provider. Again, the
options depend on your location, budget, time constraints and other
factors, so it is worth doing your research before commiting to
anything.



## Age and gender specific information {#specific}

[children](children.md)                                             --
[men](men.md)                                                       --
[women](women.md)                                                   --
[non-binary](nonbinary.md)


## How to buy HRT yourself {#buy}

It is possible to buy HRT online. Often called self-medding,
self-prescription, self-prescribing, self-medication or self-medicating or
*DIY HRT*,
it is fully legal in most countries. This page attempts to provide safe
instructions, for purchasing and administering HRT without a prescription.
This includes information on blood tests, and endocrinology. Doctors often
refer to this as *self-prescribed hormones*.

When a transgender or trans person wishes to begin taking hormones, they may
run into some problems (gatekeeping doctors, long waiting times, and so on).
This can cause some distress, for some people. If you are one of them, then
DIY HRT can be a good alternative.

**We are NOT medical doctors. You are responsible for your own health, and we
take ZERO responsibility if you don't do your research properly before
self-medicating. We try to provide accurate information on this page, but
we cannot guarantee it. You should seek proper medical advice. Self-medication
is a last resort (e.g. gatekeeping doctors, or long waiting times to receive
hormones from your doctor).**

If you're a child in the UK, you *should* at least self-medicate on puberty
blockers if possible, ideally full cross-hormones. Ask your parents to take you
to see GenderGP, a private gender clinic, which is listed on our [list of
private trans clinics](private-care.md) - they have been known to provide full
HRT to children in the past. Their waiting times are low (NHS's waiting times
are literally years, and you will go through your natal puberty if you're left
waiting for NHS treatment only).

Otherwise, and especially if you're an adult, we recommend private treatment if
you can afford it, instead of self-medicating. Your waiting times will be
considerably reduced. You should also get yourself immediately on the waiting
list to see someone at a gender clinic, on the NHS, if your country has
publicly funded healthcare. Note that in some states in USA, medicaid covers
trans care; check if it's available for this purpose, to you, in your state, if
you can't get decent health insurance.

NOTE: this page only contains information about estradiol-based HRT. We
currently lack information for trans men and non-binary people, and we would appreciate
help adding this information to the page.

If you have such information to provide us, then could you get in touch with us?
Our contact details (IRC chatrooms) are mentioned on the homepage.


### Check whether you're intersex {#intersex}

**Ignore the doses on this page and do not self-medicate at all, if you
are intersex. You will require special treatment, under close medical
supervision from a doctor.**

This page has information about what intersex means:
<https://nonbinary.miraheze.org/wiki/Intersex>

The endocrine system is the collection of glands that produce hormones
that regulate metabolism, growth and development, tissue function,
sexual function, reproduction, sleep, and mood, among other things.

You can go to an endocrinologist. This is recommended anyway, because an
endo can tell whether HRT is safe for you to take, along with blood
tests. An endocrinologist can check whether you're intersex; this means
having sexual characteristics of both male and female. Being intersex
can have an effect on what type of hormone therapy is suitable for you.
For instance, your doctor might put you on a lower dose of hormones than
if you were not intersex.

In the UK, you can get a referral from a GP. If you're already
receiving treatment from a GIC, they can also refer you to an
endocrinologist.

In the UK, [Dr. Leighton J
Seal](http://gendercare.co.uk/leighton-seal.html) is one of the most
well known endocrinologists specializing in endocrinology for
transgender people, including intersex. However, you might also have
luck with another endo if you don't live near London (where Seal
operates). If you can, we recommend seeing Dr. Seal.


### External links

<https://madgenderscience.miraheze.org/wiki/Main_Page> also has
information about self-medication.


## Suppliers {#suppliers}

These companies are overseas (none of them are in the UK), and you can
import HRT into the UK. It's legal to import HRT for your own personal
use. Order no more than a 6 month supply per order. A 3 month supply
would be safer.

**[InhousePharmacy.vu](https://www.inhousepharmacy.vu/default.aspx?):**

InhousePharmacy is well-known and commonly used by trans people when
self-medicating. It has existed for a number of years, and the meds that
they provide are the real thing.

The box that arrives will say "pharmaceuticals" on it. If you need to
receive them secretly, without someone (e.g. parents) knowing, then you
should use a PO box or a friends house, or anywhere where you can
receive them safely.

Recommended pills (trans women):

- Spiractin 100 (spironolactone)
- progynova 2mg (estradiol valerate)

NOTE: GnRH antiandrogens (e.g. decapeptyl) are vastly superior to anything
else as anti-androgen, in that they fully suppress testosterone. However, we
do not recommend using this on DIY; get it from your doctor (it has to be
injected every so often. Do *not* self-inject unless you know what you're
doing)

NOTE: spironolactone is a weak antiandrogen, and causes increased pottasium
build-up in the body. We do not recommend taking spironolactone, unless you
can't get another antiandrogen that is better.

Spironolactone doesn't suppress T, but blocks some of its effects, so T may
seem high on blood tests. Spironolactone also affects estradiol readings on
blood tests (they'll be higher than they actually are on the test).

NOTE: progesterone is not proven to increase feminization, and can lead to
further negative side effects. We do not recommend taking progesterone.

**[Quality Health Inc](https://www.qhi.co.uk/):**

This supplier ships to Portugal (Inhouse does not, last time we
checked). For other people who can't order from Inhouse, this company
might also be usable.

The box that arrives will be blank, with no information on it from the
outside. This is good if you need to receive it discretely (e.g. at
parents house).

**TODO: add more suppliers**


